Scholarship Qualifications TIP-CC-013 Revision Status/Date: 3/2018 DEC 05

TECHNOLOGICAL INSTITUTE The Senior High School graduate must:

OF THE PHILIPPINES  Possess a GWA of 85% with no grade in any subject below 83% on
first semester
CAREER CENTER  Not be enrolled in any college/ university prior to this examination

PRIVACY CONSENT
I understand and agree that by filling out this form I am allowing the Technological Institute of the Philippines to collect, process, use, share, and disclose my personal information for
Application for Scholarship Examination and also to store it as long as necessary for the fulfillment of the stated purpose and in accordance with applicable laws, including the
Data Privacy Act of 2012 and its Implementing Rules and Regulations, and the T.I.P. Privacy Policy. The purpose and extent of collection, use, sharing, disclosure, and storage of my
personal information was explained to me.

APPLICATION FOR SCHOLARSHIP EXAMINATION

NAME OF EXAMINATION DATE TIME PLACE Please attach

 Engr. Demetrio A. Quirino Jr. Scholarship Grant Feb. 2, 2019 9:00 a.m. – 12:00 n.n. recent 2”x 2”
 Dr. Teresita U. Quirino Scholarship Grant Feb. 9, 2019 9:00 a.m. – 12:00 n.n. picture

Please PRINT CLEARLY.

Surname First Name Middle Name Signature
Permanent Address Contact Number:
Date of Birth: Gender : Senior High School Strand:
 Male  Female
Senior High School: School Address: Type of School:
 Public  Private
General Weighted Average: Honors: Preferred Program:

Checklist of Requirements Submitted:  Chemical Engineering  Mechanical Engineering  Architecture

 Civil Engineering  Marine Transportation  Education
 Copy of Senior High School Report Card (Form 138) or Certified  Electronics Engineering  Marine Engineering  Accountancy
Copy of Grades  Electrical Engineering  Environmental & Sanitary
 One (1) copy of 2” x 2” ID Picture Engineering
 Copy of Grade 12 School I.D.

Source of Information about the Scholarship Examination:

Select one ( ).
 Walk-in Applicant  T.I.P. Student  T.I.P. Website/Internet
 SHS Career Orientation  T.I.P. Alumni  Newspaper Ads
 T.I.P. Flyer/Poster  T.I.P. Employee  Others, specify__________________________
Examinee No. Room No. Recommended by:

Name and Signature /Date

TECHNOLOGICAL INSTITUTE TIP-CC-013 Revision Status/Date: 3/2018 DEC 05

OF THE PHILIPPINES
CAREER CENTER SCHOLARSHIP EXAMINATION PERMIT

NAME OF EXAMINATION DATE TIME PLACE

 Engr. Demetrio A. Quirino Jr. Scholarship Grant Feb. 2, 2019 9:00 a.m. – 12:00 n.n.
 Dr. Teresita U. Quirino Scholarship Grant Feb. 9, 2019 9:00 a.m. – 12:00 n.n.

Please PRINT CLEARLY.

Surname First Name Middle Name Examinee No. Room No.

REMINDERS:
1. Bring this EXAMINATION PERMIT, BLACK INK BALL PEN, PENCIL and GRADE 12 SCHOOL I.D. on the examination day.
2. Books, notes and calculators are not allowed in the examination room.
3. The examination starts promptly at 9:00 AM. You must be at your designated room 30 minutes before the start of the examination.
IMPORTANT: Scholarship will be valid only if the senior high school student graduates within the current school year.
For inquiries, pls. call: Manila Campus: Tel. No. 733-9117/ 736-4208/ 736-2580 Quezon City Campus: Tel. No. 911-0964/ 912-1539 / 911-7199 www.tip.edu.ph